What Health Reform Means to You

The smoke has settled, the votes are in, and health reform is real. We’ve all heard about the supposed benefits and drawbacks of the reform package, which includes new rules on coverage for insurers, a mandate that almost every uninsured American citizen get coverage, new taxes, and cuts in Medicare. While others debate whether reform will lead to a healthier and fairer America, or to its ruin, we know you’re concerned about how the new landscape will affect you and your practice.

The short answer: It won’t affect you much in the short-term but could impact you considerably down the road. Here’s a look at what happens when:

2010: New high-risk insurance pools will be established for adults who haven’t been able to get access to coverage. Insurers won’t yet be required to cover them, though. They will, however, be required to cover children with pre-existing conditions. Also, small business will see the first installment of tax credits designed to encourage them to offer employee coverage. All this means that you might start seeing some new patients this year - particularly children with complex conditions, who may have had little more than an initial diagnosis. Medicare, meanwhile, will begin a gradual process of closing its prescription drug “doughnut hole,” so some of your senior patients may start asking about medications they couldn’t afford before.

2011: Medicare begins covering annual wellness visits. So you’ll need to determine how you want to handle these visits - you’ll likely get a lot of requests. The phase-out of so-called Medicare Advantage plans will begin. And the Center for Medicare and Medicaid Innovation begins - this is what opponents labeled a “death panel.” Its job will be to test out ideas for delivering better care for less money. To the extent that CMS accepts its recommendations on what to cover, this new Innovations Center may affect you significantly.

2012-2013: These years are relatively quiet. There will be some new tax incentives for business to offer coverage, and some new money to encourage primary-care services. And some new taxes - such as a tax on medical devices - kick in.

2014: This is the year that the individual mandate begins; most Americans that don’t yet have coverage will be required to purchase it. Many of the economic incentives and subsidies begin this year, too, and do new rules forbidding insurers from denying coverage to, or rescinding it from, anyone. That means physicians will likely see a crush of new patients this year.

2015: Big battles are possible this year over Medicare reimbursement policies - even bigger than the usual battles. That’s because an Independent Payment Advisory Board - supposedly more powerful than the Medicare Payment Advisory Commission - begins its work.